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<h2>FCC BC Membership Application<a id="start" name="start"></a></h2>
<p>(Only $20 a year per family)</p>

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<tr>
<th>Parent's Family Name</th>
<th>Given Name</th>
</tr>
<tr>
<th>&nbsp;</th>
<th>&nbsp;</th>
</tr>
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<th>&nbsp;</th>
<th>&nbsp;</th>
</tr>
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<tr>
<th>Child's Family Name</th>
<th>Given Name</th>
<th>Sex</th>
<th>Birth date</th>
</tr>
<tr>
<th>&nbsp;</th>
<th>&nbsp;</th>
<th>&nbsp;</th>
<th>&nbsp;</th>
</tr>
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<th>&nbsp;</th>
<th>&nbsp;</th>
<th>&nbsp;</th>
<th>&nbsp;</th>
</tr>
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<th>&nbsp;</th>
<th>&nbsp;</th>
<th>&nbsp;</th>
<th>&nbsp;</th>
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<th>&nbsp;</th>
<th>&nbsp;</th>
<th>&nbsp;</th>
<th>&nbsp;</th>
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<br>

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<tr>
<th>Address</th>
</tr>
<tr><th>&nbsp;</th></tr>
<tr><th>&nbsp;</th></tr>
<tr><th>&nbsp;</th></tr>
<tr><th>&nbsp;</th></tr>
<tr><th>&nbsp;</th></tr>
</table>
<p class="fineprint">(If moving, please indicate old/new address.)</p>

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<th>E-mail address</th>
<th>Telephone</th>
</tr>
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<th>&nbsp;</th>
<th>&nbsp;</th>
</tr>
</table>

<p>
Please complete this registration form and post with cheque made out to FCC BC:
</p>
<ul>
<li>FCC BC</li>
<li>c/o Unit 52 - 65 Foxwood Drive</li>
<li>Port Moody, BC  V3H 4Z5</li>
</ul>

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